Expanding pharmacy services while controlling labor costs with … · 2018-11-26 · Expanding...
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1
Expanding pharmacy
services while controlling
labor costs with remote
pharmacy models
November 8, 2018
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Featured speakers
Dr. Bala S. Chandrasekhar
Chief Medical Officer
Methodist Hospital of Southern California
Arcadia, California
John Coggins
Director of Pharmacy
Mary Washington Hospital
Fredericksburg, VA
Kelly Morrison
Director, Remote & Retail Pharmacy Services
Cardinal Health
Houston, Texas
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Kelly MorrisonDirector of Remote & Retail Pharmacy Services
Cardinal Health
Houston, Texas
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Discussion overview
• How are marketplace trends impacting your hospital pharmacy?
• Could remote pharmacy models be successfully leveraged to
enable initiatives at your hospital?
• Two hospitals share their experiences with expanding their
pharmacy’s reach and elevating patient care
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Trends in the marketplace
✓ Doing more with less is the “new normal”
✓ Increased need for pharmacy-led, clinical programs to drive
hospital cost savings initiatives, reduce readmissions and
increase patient satisfaction
✓ Technology conversions driving negative impact to operating
earnings
✓ Increased focus on retail strategy
✓ Personnel and project budgets are flat despite growing
hospital administration expectations
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Remote pharmacy services myths
1. Outsourcing costs more than hiring additional FTEs
2. Remote pharmacy services can only be leveraged through a
long-term agreement vs. short-term need
3. We already have a 24/7 pharmacy so there is no need to
consider remote services
4. Remote pharmacists are ‘generalists’ and will not be able to
handle the complexity of our patient population
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Dr. Bala S. ChandrasekharChief Medical Officer
Methodist Hospital of Southern California
Arcadia, California
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About Methodist of Southern California
• Founded 1903 in downtown Los Angeles; in Arcadia since
1957
• 348 licensed beds; 40 ICU beds; 12 ORs; 3 cardiac
angiography suites
• 680+ medical staff; >90% Board Certified
• Fully accredited by The Joint Commission
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About Methodist of Southern California
Focus on quality, safety and excellence:
5-Star Rating for Overall Hospital Quality
(Medicare 2016-2018)
Ranked in Top 1% in nation for patient safety
(SafeCare Group –2016-2018)
Distinguished Hospital Award for Clinical Excellence
Top 5% in nation
(HealthGrades - 2017)
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Patient safety and quality strategic plan
Sustain position as one of the safest places in the nation
to receive care
• Engage effectively with practitioners to reduce medical errors
• Expand clinical pharmacist role in patient education
• Optimize antibiotic stewardship program
• Expand medication reconciliation and discharge medication
review
• Improve patient experience and HCAHPS scores
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Pain points in pharmacy
• Increasing costs (operations and drugs)
• Flat HCAHPS scores for discharge instructions, patient
understanding of medications
• Poor adherence to medication reconciliation
• Nursing responsibilities for patient education
• Minimal involvement of pharmacy staff in patient centered care
• Pharmacist resources underutilized
11 © 2018 Cardinal Health. All Rights Reserved. FOR INTERNAL USE ONLY.
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The challenge: “do more with less”
Reallocate pharmacy staff to support hospital initiatives
• Limited order entry/verification duties
• Pharmacist stationed at the main pharmacy vs on floors
• Limited interaction with patients and healthcare professionals
• Develop and train clinical pharmacist
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The solution: leverage remote pharmacy
Supplement onsite pharmacy staff with remote pharmacy team
• Utilized 3 FTEs for coverage
• Scaled up as needed: coverage during short staffed months and
PTO
• Remote pharmacists process 40% of the total monthly order
volume
• Trained and transitioned onsite pharmacists to patient care units
• Monitor and track success of the clinical program
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Results: clinical pharmacy metrics
Start of remote
order entry
Q1
Remote order entry
+ Clinical
Q2
ASP/Antibiotic-related interventions 106 218
Anticoagulation-related interventions 62 162
Patient/family member counseling NA 40
Drug-information provision to
physicians, Nursing and patients on
the floor
NA 105
CPOE assistance provided to
MD/PA/NP
18 38
Discharge medications counseling NA 37
✓ Increase in interventions
✓ Ability to increase interactions with patients and staff
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Results: HCAHPS scores
Communication about Medication Discharge Information
57.557.7
62.3
21.3 22.417.6
9.6 10.1 9.5
11.6 9.8 10.6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2016 2017 2018
Never
Sometimes
Usually
Always
69
64
84.986.1
86.8
15.1 13.9 13.2
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2016 2017 2018
No
Yes
87
90
• Improved patient experience and HCAHPS scores in 2018
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Results: antibiotics cost
Clinical
programs
AVG COST SAVINGS PER MONTH: $41,923.33• Approximately 32% cost savings per month for Antibiotics
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Conclusion
Leveraging a remote pharmacy model enabled:
✓ Decreased drug costs
✓ Successful implementation of clinical pharmacists’ programs
✓ Increased interaction with physicians, nurses and patients
✓ Increased clinical interventions
✓ Improved patient experience and HCAHPS scores
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John CogginsDirector of Pharmacy Mary Washington HospitalFredericksburg, VA
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About Mary Washington
Mission
To improve the health of the people
in the communities it serves
Two-hospital system in Fredericksburg, VA
• Mary Washington Hospital (450 beds) and Stafford Hospital
(100 beds)
• Level 2 trauma and NICU
Ranked in US News World Report
• Best hospitals in Washington metro area, # 6 in Virginia,
# 3 DC metro area
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The challenge
Staffing burden due to turnovers
• Retaining 2 pharmacists on night shift was difficult to maintain
• Recruiting difficulty due to location and proximity to DC
Needed staffing support for technology conversion (EPIC)
• Staff at capacity – challenge to free up pharmacists to take
training and keep pharmacy running pre and post conversion
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The solution
Leveraged remote pharmacy team to supplement on-site
pharmacy staff
• Utilized remote pharmacy to process 65% overnight orders
• Transferred overnight order for Stafford to remote pharmacy
• Maintained one pharmacist on-site and supplemented with one
remote pharmacist
• Used onsite pharmacist to do clinical consultation and manage
on-site pharmacy
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The solution
Leveraged remote pharmacy team to support EPIC conversion
Scaled up during EPIC conversion to ensure staff had time for
training for cut-over and go-live dates
Increased pharmacist coverage
• Pre-cut over: Daytime coverage; two remote pharmacist
• Cut-over day: Six remote pharmacy staff and had on-site
support from remote pharmacy director
• Go-live weekend: Day time coverage and evening coverage; two
remote pharmacists; converted to one remote pharmacist on
days through the month of conversion
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Results
Patient and staff satisfaction
• Verification went from 70 min to average of 15 min (technology,
RPS combined achieved this)
• Reduced staff feeling overwhelmed and overworked
• Solved for lean staffing challenges
Maintained productivity
• Ability to scale up or down depending on current needs
Financial savings
• Reduce the amount overtime dollars paid
• Estimated savings to date: $26K
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Kelly MorrisonDirector of Remote & Retail Pharmacy Services
Cardinal Health
Houston,Texas
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Benefits of remote models
Operational
• Enables pharmacy full commitment without distractions when
engaging in training and implementation of new system
• Ensures pharmacy service levels are consistent when pharmacists are
pulled away temporarily or redeployed to clinical initiatives
Financial
• Eliminates costs associated with recruiting, training and benefits
Cultural
• Enables pharmacy to scale staff as needed without impacting FTE
personnel
• Demonstrates leadership’s commitment to work/life balance and job
satisfaction
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The role of remote pharmacy services
• Expands the pharmacists’ reach in transitions of care
• Supports the improvement of clinical outcomes
• Increases pharmacy and hospital access to patients
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Thank you